Clin Exp Emerg Med.
2017 Sep;4(3):128-132. 10.15441/ceem.16.169.
Emergency department point-of-care ultrasonography improves time to pericardiocentesis for clinically significant effusions
- Affiliations
-
- 1Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel. evanavrahamalpert@gmail.com
- 2Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel.
- 3Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel.
- 4Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- KMID: 2401240
- DOI: http://doi.org/10.15441/ceem.16.169
Abstract
OBJECTIVE
Our objective was to determine the utility of point-of-care ultrasound (POCUS) to identify and guide treatment of tamponade or clinically significant pericardial effusions in the emergency department (ED).
METHODS
This was a retrospective cohort study of non-trauma patients who were diagnosed with large pericardial effusions or tamponade by the ED physician using POCUS. The control group was composed of those patients later diagnosed on the medical wards or incidentally in the ED by other means such as a computed tomography. The following data were abstracted from the patient's file: demographics, medical background, electrocardiogram results, chest radiograph readings, echocardiogram results, and patient outcomes.
RESULTS
There were 18 patients in the POCUS arm and 55 in the control group. The POCUS arm had a decreased time to pericardiocentesis (11.3 vs. 70.2 hours, P=0.055) as well as a shorter length of stay (5.1 vs. 7.0 days, P=0.222). A decreased volume of pericardial fluid was drained (661 vs. 826 mL, P=0.139) in the group diagnosed by POCUS.
CONCLUSION
This study suggests that POCUS may effectively identify pericardial effusions and guide appropriate treatment, leading to a decreased time to pericardiocentesis and decreased length of hospital stay. Pericardial tamponade or a large pericardial effusion should be considered in all patients presenting to the ED with clinical, radiographic, or electrocardiographic signs of cardiovascular compromise.
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